November 10, 2009

Ms. Kimberly Rice MLT (ASCP)
ICON Development Solutions
8307 Gault Lane
San Antonio, TX 78209

Dear Ms. Rice:

Thank you for your letter to the Occupational Safety and Health Administration (OSHA). Your letter was forwarded to OSHA's Directorate of Enforcement Programs (DEP) for a response. You requested a written reply regarding the Occupational Safety and Health Administration's (OSHA) position regarding the confidentiality of employee post-exposure evaluation results as it pertains to the Bloodborne Pathogens Standard, 29 CFR 1910.1030. This letter constitutes OSHA's interpretation only of the requirements discussed and may not be applicable to any question not delineated within your original correspondence. We apologize for the delay in responding to your inquiry.

Scenario: A small healthcare facility with physicians on staff is concerned about acceptable procedures for offering post-exposure follow-up and counseling to employee(s) involved in exposure incident(s).

Question 1: Are employers required to send employee to an outside physician in the event of an exposure incident for the post-exposure evaluation? Is it a breach of confidentiality for one of our physicians to perform the post-exposure evaluation?

Response 1: In accordance with 29 CFR 1910.1030(f)(3), a confidential medical evaluation and follow-up must be made immediately available to employee(s) after the report of an exposure incident. The standard does not prohibit facilities from offering the post-exposure evaluation and follow-up on-site, if a mechanism is in place to ensure confidentiality. The boundary between employer and healthcare professional may be blurred in a medical setting in which, for example, the physician is both the employer and the evaluating healthcare professional. It would be inappropriate for the post-exposure medical evaluation to be done by a person who also supervises the exposed employee(s). In circumstances where the employer cannot ensure employee confidentiality from an in-house evaluation and follow-up, the option of independent (outside) post-exposure testing and evaluation must be used.

Question 2: Is it acceptable to have portable fans in work areas such as phlebotomy collection rooms? Would the use of the fans in these areas compromise the integrity of the specimens or patient safety?

Response 2: The use of personal fans for personal cooling is acceptable in the workplace setting depending on how the fans are listed and labeled. 29 CFR 1910.303(b)(2) requires that listed or labeled equipment shall be used or installed in accordance with any instructions included in the listing or labeling. Also, the use of fans should be such that it does not create a greater hazard to employees (e.g., it should not increase the chances of aerosolizing blood/specimen during collection or from an accidental spill).

Your question regarding the concern for patient safety is outside OSHA's jurisdiction. Our agency is limited to covering public health issues affecting worker safety and health.

Thank you for your interest in occupational safety and health. We hope you find this information helpful. OSHA requirements are set by statute, standards, and regulations. Our interpretation letters explain the requirements, and how they apply to particular circumstances, but they cannot create additional employer obligations. This letter constitutes OSHA's interpretation of the requirements discussed. Note that our enforcement guidance may be affected by changes to OSHA rules. Also, from time to time we update our guidance in response to new information. To keep apprised of such developments, you can consult OSHA's website at http://www.osha.gov. If you have any further questions, please feel free to contact the Office of Health Enforcement at (202) 693-2190.

Sincerely,



Richard E. Fairfax, Director
Directorate of Enforcement Programs